Some of the highest penalties are for hospitals keeping ambulances carrying patients waiting outside because they are too busy.

Paramedics are expected to transfer people within 15 minutes but at hospitals run by the Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) the time is often more than double that target.

Last winter alone, between November and February, 594 ambulances were kept waiting for more than 30 minutes at Queen’s Hospital, in Romford, and King George Hospital, in Barley Lane, Goodmayes.

There are plans to close King George’s A&E, although there is no date for the move, which residents, councillors, campaigners and MPs have been fighting for years.

If the fines that were introduced in April were in place last winter, the trust would have been charged at least £118,800.

And the amount could have been even higher if any of those waits were above an hour.

Transfers over 30 minutes incur a £200 fine, which jumps to £1,000 per patient for 60 minutes or more.

The new contract also brings in financial penalties for missing targets to treat people within four hours, leaving patients on trolleys when wards are full, and outside A&E for delayed operations, waits for cancer treatment and slow test results.

But the Royal College of Nursing has warned that taking more money from beleaguered A&E departments will just “add to the problem”.

London operational manager Sue Tarr said: “There is a good and urgent case for additional funding for hospitals to deal with these problems.

“Diverting money away from A&E units that are already struggling to cope makes no sense at all.”

The fines could pose a particular risk to BHRUT, which is already in an estimated £150million of debt.

Chief executive Averil Dongworth said: “While we are keen to avoid fines for delays, it is far more important to us to improve performance so that our patients have the best possible experience.

“Ambulance patients are assessed by a senior Trust clinician as soon as they arrive at the hospital so that those who need rapid treatment can be admitted into the department and seen without delay.”

She added that the trust is developing an “improvement plan” with partners.

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